Verge 5 Roland 1 The Sheppard and Enoch Pratt Hospital: A Moral Architecture Holly Roland Those from the Baltimore area are likely to be familiar with The Sheppard and Enoch Pratt Hospital, more colloquially known as Sheppard Pratt, located in the suburb of Towson, Maryland. For more than a century, Sheppard Pratt has been recognized not only for its acclaimed treatment of the mentally ill, but also for its pioneering and therapeutically-centered architecture. Built in a century when mental institutions were alarmingly bleak and severe, Sheppard Pratt constructed its famed A and B Buildings with the wellness of their patients in mind. Although time has brought many changes to facets of Sheppard Pratt’s architecture and landscaping, the institution’s original vision remains intact. Patients’ mental health is still the hospital’s primary goal; healing continues to be accomplished through the unique environment provided by Sheppard Pratt’s complex and beautiful architecture. Before one can understand the importance and grandeur associated with the physical structures of Sheppard Pratt, it is necessary to investigate the history of mental institutions in the United States prior to its construction (see image 1). People who were considered to be touched by insanity were mocked, isolated, mistreated, and even exterminated. In 1853, doctors defined the condition as a disease of the thinking, reflecting, and voluntary powers of man: “In some instances, insanity’s manifestation is partial, and in others there is total pervasion of functions. [Insanity] is hereditary and accidental, and once established, may be transmitted with as much certainty as Phthisis Pulmonalis or the Scrofulous Taint.” 1 The general population often associated manifestations of insanity with religious wrongdoings or supernatural influences, and because of such misconceptions about mental illnesses, those who suffered from them Verge 5 Roland 2 faced a spectrum of inhumane treatment. Even if the use of chains and raw brutality was mostly abandoned by the early nineteenth century, superintendents of early asylums were still encouraged to use fear, threats, and if necessary, physical force to keep their dangerous lunatics under control. 2 What were considered “harmless punishments” and intimidations were allowed if, for example, an obstinate patient refused to eat. “It is never impossible, even by force, to oblige patients to swallow,” 3 hospital officers explained. During the time of questionable patient treatment in America, asylums were considered to be prisons with a milder name.4 Even many of the large state hospitals designed to treat the mentally ill, because of their numerous patients and subsequent lack of resources, had become dehumanizing and insufficient. The conditions of such facilities did not benefit patients, and in some cases, undoubtedly worsened their existing conditions. Eventually, by the nineteenth century, the origins of deviant behavior were beginning to be blamed on the faulty organization of communities instead of the ill individual. As a result of this belief, the building of asylums increased: “In 1820, only one state hospital for the mentally ill existed in the United States. By the Civil War, virtually every state had established one or more institutions for that purpose.” 5 These new asylums reflected the obsolescence of the past and continued as part of the changing society. On one level they were ‘white elephants’ in history, but on another level, they reminded us of the human thought and transformative aspect of our culture. 6 The campaigning of mentally ill advocates, such as Dorothea Dix, was slowly beginning to change the barbaric methods and conditions of many institutions, but this change was laden with challenges. By the 1880s, approximately one-hundred and forty 7 mental hospitals, both private and public, were caring for patients throughout America. Verge 5 Roland 3 However, the seemingly impressive numbers were disguising the fact that the majority of these institutions experienced an array of unresolved problems. Since the time of their admittance, most patients failed to indicate signs of significant improvement. These supposedly “therapeutic” structures, originally designed for a small number of patients in order to promote restorative relationships, increasingly grew in size because states were slow to build new facilities to match the escalating mentally ill population. According to an 1880 census, “there were 91,997 insane persons out of a total American population of 50,000,000. Thirty years earlier the comparable statistics were 15,610 out of 21,000,000.” 8 Hope for patient improvement emerged once physicians began to realize that applications of purging, bleeding, blistering, emetics, and lobotomies were rarely effective on the insane, 9 but due to the high demand of health care, superintendents struggled to successfully apply psychiatric theory to the institutional reality. Asylums’ poorly designed architecture and planning did not allow for successful treatment and healing. Because of the discrepancy between the need for space and amount available, as well as the disappointing treatment results, the public’s image and support of mental institutions quickly fell. However, society’s perception would thankfully shift, thanks to influences like Dorothea Dix. Dorothea Dix traveled throughout the US and abroad to promote humane care for the mentally ill. She had been an important authority on the subject in 1852, when the Legislature passed the first act that provided the first institution for care of the insane. 10 The appeal of Miss Dix was ordered and printed by the Legislature and undoubtedly did very much to secure the passage of an act which eventually resulted in the erection of the 11 Spring Grove Hospital at Catonsville. Dix was in association with Moses Sheppard, a Verge 5 Roland 4 wealthy Quaker from Baltimore who shared her strong interest in social causes (see image 2). Sheppard, the founder of Sheppard Pratt, started developing his ideas for a revolutionary mental institution at the Maryland Legislative session of 1853. 12 Shortly after Dix had visited Maryland during her campaigning, he drew up a charter for the board of trustees, which was obtained at a session of the General Assembly. On his death in 1857, Sheppard left an amount of $567,632.40, the largest bequest ever given for mental health in the country at that time, for the erection of what would become The Sheppard and Enoch Pratt Hospital. 13 The transition of the idea of Sheppard Pratt to the reality of a tangible asylum was a belabored and collaborative process. The asylum’s buildings were planned and implemented only after the careful study of the pros and cons of similar structures in various parts of the world. Before his death, Sheppard visited and took into consideration the designs and construction methods of small, private hospitals, such as the York Retreat in England, The Bloomingdale Hospital in White Plains, New York, and the Hartford Retreat in Connecticut. 14 Sheppard Pratt’s design was a collaboration between prominent landscape architects Calvert Vaux and Fredrick Olmstead, landscape designer Howard Daniels, and psychiatrist Dr. B. Tilden Brown. Vaux, at the time, was a well-known landscape architect; much of the public knew his and Olmstead’s collaborative work on New York City’s Central Park. Daniels designed Druid Hill Park in Baltimore and had lost out to Vaux and Olmstead’s design for Central Park. 15 All men were advised by Dr. Tilden Brown, the former superintendent of Bloomingdale Asylum in New York. 16 To aptly gauge Sheppard Pratt’s intended design, it is helpful to compare it to The Buffalo State Hospital (see image 3), currently named The Buffalo Psychiatric Center. Verge 5 Roland 5 This hospital was built alongside Olmstead and Vaux’s northern tranquil landscaping in New York; although a public institution, it greatly paralleled Sheppard Pratt. Both are large mental hospitals, built in America after the Civil War, that were based on the humanitarian spirit of social reform. Vaux and Olmstead believed, in relation to The Buffalo State Hospital and Sheppard Pratt, that “beauty [was] an important element in the successful treatment of insanity” and wished to create natural conditions in both settings that “promoted tranquility and rest to the mind.” 17 Back in Maryland, Vaux, Olmstead, and Brown agreed to adopt the Kirkbride Model of hospital design, which was quickly becoming a more popular hospital style in America. It was considered an architectural response to the challenge of treating insanity. Dr. Robert Kirkbride, also a Quaker, was moved by the humane ideas towards the insane that had been introduced throughout England. He was greatly invested in the investigation and alleviation of mental illness; he was one of the founding members of the Association of Medical Superintendents of American Institutions for the Insane, which eventually became the American Psychiatric Association. 18 By 1890, approximately seventy hospitals built using the Kirkbride Model existed in the United States. 19 Hospitals based on this model represented an optimistic and progressive vision of medical care for the mentally ill. Sheppard Pratt’s design is an adaptation of the Kirkbride Model. Essentially, the model’s design consisted of a central administration building, although this aspect is not seen in Sheppard Pratt, and additional structures separately designated for men and women. Buildings were intended to be large and